Impacto de la pandemia por COVID-19 y el confinamiento estricto de la población en la incidencia de fractura de cadera en España. Una revisión sistemática / Impact of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain: A systematic review

Antecedentes y objetivo Durante la pandemia por COVID-19, en España se decretó un confinamiento estricto de la población. Ante una situación de crisis sanitaria y de saturación del sistema sanitario resulta de gran importancia para la correcta gestión de recursos y de procesos el conocimiento de las enfermedades cuyo tratamiento no es demorable. El objetivo fue conocer la influencia de la pandemia por COVID-19 y del confinamiento estricto de la población en la incidencia de fractura de cadera en España. Material y método Revisión sistemática siguiendo las guías PRISMA. Búsqueda en Pubmed y Cochrane Library el 11/11/2022: hip fracture AND COVID-19 AND Spain. Resultados Cumplieron los criterios de inclusión 6 estudios, el 50% mostraron un descenso en la incidencia de fracturas de cadera durante el confinamiento estricto (todos en hospitales de la Comunidad de Madrid), y en el otro 50% no hubo diferencias (todos en hospitales de otras comunidades autónomas). Es constante que las fracturas de cadera, o no disminuyeron, o disminuyeron mucho menos que el resto de fracturas durante el período de confinamiento estricto de la población, aumentando su número relativo respecto al total de ingresos en cirugía ortopédica y traumatología. Conclusiones El comportamiento del número de fracturas de cadera durante el confinamiento estricto decretado por la pandemia por COVID-19 no ha sido simétrico en todas las comunidades autónomas. Para diseñar e implementar los planes de contingencia ante una situación de pandemia con adecuada organización de los recursos materiales y de personal, deben ser tenidos en cuenta estos datos (AU)

Background and objectivo During the COVID-19 pandemic, a strict population confinement was decreed in Spain. In a situation of health crisis and health system saturation, knowledge of pathologies whose treatment cannot be delayed is of great importance for the correct management of resources and processes. The objective was to determine the influence of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain. Material and method Systematic review following the PRISMA guidelines. Search in Pubmed and Chocrane Library on 11/11/2022: hip fracture and COVID-19 and Spain Results Six studies met the inclusion criteria, 50% showed a decrease in the hip fractures incidence during strict population confinement (all in Comunidad de Madrid hospitals), and in the other 50% there were no differences (all in other region hospitals). It was constant that hip fractures, either did not decrease, or decreased much less than the rest of fractures during the period of strict population confinement, increasing their relative number with respect to the total admissions in orthopedic surgery and traumatology. Conclusions The behavior of the hip fractures number during the strict population confinement decreed by the COVID-19 pandemic has not been symmetrical in all regions. To design and implement contingency plans in the event of a pandemic situation, these data must be taken into account in order to properly plan material and human resources (AU)

[Impact of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain: A systematic review]. / Impacto de la pandemia por COVID-19 y el confinamiento estricto de la población en la incidencia de fractura de cadera en España. Una revisión sistemática.

BACKGROUND AND OBJECTIVE: During the COVID-19 pandemic, a strict population confinement was decreed in Spain. In a situation of health crisis and health system saturation, knowledge of pathologies whose treatment cannot be delayed is of great importance for the correct management of resources and processes. The objective was to determine the influence of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain. MATERIAL AND METHOD: Systematic review following the PRISMA guidelines. Search in Pubmed and Chocrane Library on 11/11/2022: hip fracture and COVID-19 and Spain. RESULTS: Six studies met the inclusion criteria, 50% showed a decrease in the hip fractures incidence during strict population confinement (all in Comunidad de Madrid hospitals), and in the other 50% there were no differences (all in other region hospitals). It was constant that hip fractures, either did not decrease, or decreased much less than the rest of fractures during the period of strict population confinement, increasing their relative number with respect to the total admissions in orthopedic surgery and traumatology. CONCLUSIONS: The behavior of the hip fractures number during the strict population confinement decreed by the COVID-19 pandemic has not been symmetrical in all regions. To design and implement contingency plans in the event of a pandemic situation, these data must be taken into account in order to properly plan material and human resources.

Radial Nerve Paralysis in Diaphyseal Fractures of the Humerus.

One of the most common complications associated with a diaphyseal humeral fracture is the development of a radial nerve injury. We conducted a study to analyze the degree of recovery and prognostic factors associated with radial nerve palsy in patients with diaphyseal humerus fractures. We retrospectively analyzed 28 patients who presented to the Hospital La Fe, Valencia, Spain, with a diaphyseal humerus fracture associated with radial nerve injury between 2010 and 2020. A total of 14.3% (n = 4) of the patients in our cohort had open fractures and 85.7% (n = 24) had closed fractures. There were no statistically significant differences between the type of treatment and the type of fracture (p = .13). There were also no significant differences between the type of treatment and recovery time (p = .42). There was a statistically significant difference (p = .04) in the mean recovery time for patients with preoperative radial nerve injuries (11.9 months) compared with patients who sustained a radial nerve injury secondary to surgical repair of the fracture (8.6 months). The difference in recovery time between patients with open and closed fractures was not statistically significant (p = .3). Results of the study showed that the type of fracture (i.e., open or closed) did not affect radial nerve palsy recovery time. Patients who sustain radial nerve injuries secondary to a surgical repair have a shorter recovery time than patients who sustain primary radial nerve injuries.

The incidence of complications after derotational femoral and/or tibial osteotomies in patellofemoral disorders in adolescents and active young patients: a systematic review with meta-analysis.

PURPOSE: To quantify the risk of perioperative and postoperative complications of derotational femoral and/or tibial osteotomies in patellofemoral disorders (anterior knee pain and patellar instability) in adolescents and active young patients. METHODS: MEDLINE, EMBASE, Cochrane and Scopus databases were used to identify studies published from database inception and June 30, 2021. Meta-analysis was performed to pool the rates of complications related to femur and tibia osteotomies. Values of proportion of complications were expressed as proportions and 95% confidence intervals (CI) and then transformed using a Freeman Tukey double arcsine transformation. Meta-regression was used to explore factors that potentially may influence on heterogeneity such as year of publication, quality of the included studies and site of the osteotomy. RESULTS: The 22 studies identified included a total of 648 derotational osteotomies in 494 patients. Studies consisted of 20 case series (non-comparative) and 2 comparative observational non-randomized cohorts. Tibial osteotomies showed higher risk of complications than femoral osteotomies (random pooled prevalence 9%; 95% CI 4-15% versus 1%; 95% CI 0-5%, respectively, p < 0.01). The meta-regression analysis of the articles showed that the only parameters responsible of the variance in number of complications were the osteotomy site. CONCLUSIONS: Derotational femoral and/or tibial osteotomy is a safe surgical procedure in the treatment of patellofemoral disorders (anterior knee pain and patellar instability) in adolescents and active young people. LEVEL OF EVIDENCE: IV.

A new universal 3D-printable device to prevent excessive drilling in orthopedic surgery.

INTRODUCTION: The occurrence of vascular injury during drilling is a rare but severe complication. Unfortunately, drilling protection systems are not available in all hospitals. Thanks to the development of 3D printing in recent years, sharing devices and materials to solve surgical problems has become easy and inexpensive. The objective of our work is to evaluate a universal, freely accessible, 3D-printable drilling protection device. MATERIALS AND METHODS: A prospective, randomized, and triple-blind evaluation of excess drilling was evaluated in expert surgeons and resident surgeons without the use of the protection device. Subsequently, excess drilling was assessed using the device in both groups. The differences in drilling lengths between both groups with and without the device were analyzed to establish the reduction of excess drilling in both groups. RESULTS: The drilling in the expert surgeon without device group was 3.03 mm (SD 1.69 95% CI 2.40-3.66 p value = 9.89e-11), while the resident surgeon with device group performed excess drilling of 1.76 mm (SD 0.89 CI 95% 1.43-2.10). Results showed better results in the resident surgeon with device group than in the expert surgeons with device group (p value Ë‚ 0.01). The device improved drilling in both resident surgeons (5.77 mm) and expert surgeons (1.17 mm). CONCLUSIONS: The device improves drilling in both expert surgeons and resident surgeons, showing greater benefits in the latter. The device is printable with any 3D printer, making it universally accessible, inexpensive, and effective, allowing expert surgeons to improve precision in high-risk situations and resident surgeons to improve their technique without increasing risk to the patient.

Autoclave sterilization of an in-house 3D-printed polylactic acid piece: biological safety and heat-induced deformation.

AIMS: Fused filament fabrication 3D printing with polylactic acid filaments is the most widely used method to generate biomodels at hospitals throughout the world. The main limitation of this manufacturing system is related to the biomodels' temperature sensitivity, which all but prevents them to be sterilized using conventional methods. The purpose of this study is to define an autoclave temperature-resistant FFF-PLA 3D printing protocol to print 3D fractures biomodels during preoperative planning. METHODS AND RESULTS: Six different printing protocols were established, each with a different infill percentage. Ten distal radius biomodels were printed with each protocol and each biomodel was subject to 3D scanning. The biomodels were subsequently autoclave-sterilized at 134 °C and subjected to a new scanning process, which was followed by a calculation of changes in area, volume and deformity using the Hausdorff-Besicovitch method. Finally, 192 polylactic acid models were produced using the printing protocol offering the greatest resistance and were contaminated with 31 common nosocomial pathogens to evaluate the effectiveness of sterilizing the model printed using the said protocol. Sterilization resulted in a mean deformation of the biomodel of 0.14 mm, a maximum deformity of 0.75 mm, and a 1% area and a 3.6% volume reduction. Sterilization of the pieces printed using the analyzed protocol was 100% effective. CONCLUSIONS: The analyzed 3D printing protocol may be applied with any FFF-PLA 3D printer, it is safe and does not significantly alter the morphology of biomodels. These results indicate that 3D printing is associated with significant advantages for health centers as it increases their autonomy, allowing them to easily produce 3D biomodels that can be used for the treatment of fractures.

Security of 3D-printed polylactide acid piece sterilization in the operating room: a sterility test.

INTRODUCTION: 3D-printing technology has become very popular the last 10 years, and their advantages have been widely proved. However, its safety in the operating room after sterilization has not been evaluated. Thus, the use of 3D printing is still questioned. The aim of this work is to evaluate the security of polylactic acid (PLA) to print surgical models after its sterilization. MATERIALS AND METHODS: One hundred and eighty-six PLA plates and 6 negative controls without microorganisms were seeded. After 10 days of culture, the PLA plates were randomized into three groups: A, B, and C. Group A underwent a sterilization process using an autoclave program at 134 °C. Group B was seeded in different culture media and group C was used to make crystal violet stains on the biofilms formed on the PLA. Mechanical properties of PLA after autoclave sterilization including, the breaking load, deformation and breaking load per surface were calculated. RESULTS: Hundred percent of the group B showed monomicrobial growth. Stains performed on group C PLA showed biofilms in all PLA pieces. After sterilization, no pathogen growth was observed in group A during the culture observation period showing 100% sterilization effectiveness. A filling percentage of 5% obtained a breaking load of 6.36 MPa, and its elastic limit occurred after an elongation of 167.4%. A 10% infill was mechanically safe. CONCLUSIONS: Autoclave sterilization of PLA-printed pieces is safe for the patient and mechanically strong for the surgeon. This is the first 3D-printing protocol described and evaluated to implement 3D-printing technology safely in the operating room. SIGNIFICANCE AND IMPACT OF STUDY: This is the first 3D-printing protocol described to print and sterilize 3D biomodels using an autoclave showing its biological safety and its mechanical resistance.

An Innovative Weightbearing Device for Weightbearing 3-Dimensional Imaging for Foot and Ankle Surgery Preoperative Planning.

Three-dimensional preoperative planning has demonstrated multiple surgical advantages. Currently, we cannot carry out preoperative 3-dimensional planning of foot and ankle orthopedics in most hospitals due to the impossibility of performing weightbearing CT imaging. Our objective is to describe and evaluate an innovative accessible, simple, and effective device that simulates standing while in a supine position, to obtain 3-dimensional images supporting bodyweight load with a conventional CT machine. From a group of 30 volunteers, 10 patients were randomly selected and pressure and its distribution were analyzed while in a standing position in both feet. Differences between both feet were considered normal intrapersonal variability. Subsequently, the right footprint of the same 10 subjects was evaluated in the proposed loading device. Then, their pressures and distribution were compared with respect to standing and with respect to intrapersonal variability. The mean total standing pressure was 93 Kpa (standard deviation [SD] 14.32), which was reduced to 81.95 Kpa (SD 19.54) in the loading device. The load device reduced the pressure by a mean of16% (SD 22% (range -25% to -0.03%). At the hindfoot level, the loading device increased pressure by a mean of 20.59 Kpa, which expressed percentage implies an increase of 14% compared to standing. Due to its easy construction and effectiveness, this is the first device that opens the door of foot and ankle orthopedics in any hospital to 3D preoperative planning and the benefits derived from it.

Osteomyelitis, Venous Thrombosis, and Septic Emboli in a Pediatric Patient: A Case Report.

New virulence factors, such as the Panton-Valentine leukocidin (PVL), are appearing during Staphylococcus aureus infections occurring in the pediatric population. Such factors increase the aggressiveness and risk of dissemination of the bacteria, causing infections to be life-threatening. An early diagnosis is thus especially important. We present a case of osteomyelitis, venous thrombosis, and septic emboli occurring in a pediatric patient that should trigger suspicion of a PVL-positive strain. A multidisciplinary approach is necessary to enable rapid diagnosis and early treatment, which is essential for successful management of these infections. Management is based on broad-spectrum antibiotics, in combination with aggressive surgical treatment and antithrombotic therapy. In patients infected with S. aureus whose condition worsens quickly, PVL gene sequencing should be considered.

Locating the Origin of Femoral Maltorsion Using 3D Volumetric Technology-The Hockey Stick Theory.

BACKGROUND: The origin of femoral maltorsion is often unknown. However, defining the origin of the rotation of the femoral maltorsion can be useful for establishing the most suitable point to do an external derotational osteotomy. Previous studies have not considered the femoral diaphysis in their investigations of the origin of the deformity. The study of the whole morphology of the femur with 3D volumetric tools, including the femoral diaphysis can contribute to a better understanding of the behavior of femoral maltorsion. METHODS: An atypical case of unilateral femoral anteversion was selected. Both femurs were used to obtain 3D bio-models. The mirror image of the asymptomatic side was obtained and overlapped with the symptomatic femur. The Hausdorff-Besicovitch method was used to evaluate the morphologic discrepancies (in mm) between the two femurs in three zones: (1) the femoral neck, (2) the proximal diaphysis, and (3) the distal diaphysis. The differences between the two femurs were analyzed and its correlation was statistically defined using a lineal regression model. RESULTS: The deformity in the distal diaphysis increased from the supracondylar area until the apex of the antecurvatum angle (R2 = 0.91) and then decreased until the base of the femoral neck (R2 = (-0.83)), to finally increase significantly in the femoral neck area (R2 = 0.87). All of the correlations were statistically significant (p-value ˂ 0.001). CONCLUSION: The femoral maltorsion originates in the supracondylar area and its rotational axis is the longitudinal axis of the femoral diaphysis. Even though the deformity affects the femoral diaphysis, its clinical relevance is much higher in the femoral neck since the rotational axis passes through its base. Thus, the osteotomy can be conducted along all of the femoral diaphysis as long as it is done perpendicular to it.

A 3D-CT Analysis of Femoral Symmetry-Surgical Implications.

BACKGROUND: Mirroring the image of the affected side is a widely used technique for surgical planning in orthopedic surgery, especially for fractures and custom-made prostheses. Our objective is to evaluate the three-dimensional symmetry of the femurs using finite element analysis and manual alignment. METHODS: Using the computed tomography of 15 patients without lower limb pathology, 30 3D biomodels of their femurs were obtained. The error obtained through image manipulation was calculated and broken down into a rendering error and a manual overlay error. The Hausdorff-Besicovitch method was applied to obtain the total asymmetry. The manipulation error was theb subtracted from it to obtain the intrapersonal asymmetry. RESULTS: The mean intrapersonal asymmetry was 0.93 mm. It was obtained by subtracting the error derived from rendering and alignment of 0.59 mm (SD 0.17 mm) from the overall mean error of 1.52 mm (SD 1.45). CONCLUSIONS: Intrapersonal femoral asymmetry is low enough to use the mirror image of the healthy side as a reference for three-dimensional surgical planning. This type of planning is especially useful in deformity surgery when the objective of the surgery is not to restore only one specific parameter but to obtain a general functional morphology when a healthy contralateral femur is available.

Ankle torque-related fractures and its echo-fast diagnosis protocol.

Ankle torque is the most frequent injury mechanism encountered in traumatology. It usually develops as an ankle sprain, and often produces an ankle fracture. Signs and symptoms are very unspecific on the differential diagnosis, and conventional radiographs must be obtained to confirm it. This study compares ultrasound and standard X-ray images values found in ankle sprain-related fracture diagnoses. A 3-month prospective study was carried out on 52 patients with ankle torque. First, an ultrasound diagnosis was made by the first researcher at their arrival to the emergency department, usually consisting of a longitudinal section of the fibula, tibia, and V metatarsal. Then, a blinded independent investigator carried out the usual diagnosis protocol using traditional radiographs. When the required number was obtained, a third independent investigator evaluated the results. A Chi-squared test was used to contrast the outcomes between sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) comparing a non-inferiority hypothesis of our protocol against standard X-ray images screening. Echography showed to be at least as good as standard radiographs on the screening of ankle torque-related fractures (p = 0.02). In our series of patients, nearly 8% of fractures are misdiagnosed with plain radiographies, which concurs with the lower limit found in the bibliography. All the false negatives on radiographs were true positives in the first ultrasound assessment. The average time for the ultrasound protocol was 42 s. An ultrasound is at least as effective as conventional X-ray images when used in diagnosing ankle sprain-related fractures, regardless of age or sex and could in fact be better. The use of echography could reduce the number of radiographies performed when diagnosing these kinds of fractures, thereby reducing the amount of radiation exposure and expediting the diagnostic process as well as the "in situ diagnosis".Level of clinical evidence 2 [prospective cohort (N > 30 patients) study].

Cobb angle measurement with a conventional convex echography probe and a smartphone.

BACKGROUND CONTEXT: Serial X-rays are needed during the follow-up of adolescent idiopathic scoliosis. They are done every 6 or 3 months in cases of high risk of progression. Thanks to the advances in ultrasound techniques, deformity measurement systems free from ionizing radiations have been validated, although spinal surgeons did not use them routinely due to the need of special software. OBJECTIVE: The aim of our work is to assess the reproducibility and correlation of an ultrasound measuring system based on the positioning of the transverse processes. STUDY DESIGN: Prospective, single center, randomized, triple blinded. METHODS: Two independent researchers trained in ultrasound examined the spinal deformities of 31 children. The measurements were compared against those performed with an X-ray by three scoliosis expert surgeons. Statistics were performed by an independent researcher. Parametric methods were used. RESULTS: We found a 95% [(0.91-0.97) p < 2.2e-16] correlation between the degree of scoliosis measured with the proposed ultrasound system and the 30 cm × 90 cm X-rays in standing position. There was an intra-observer reliability of 97% [r-squared = 0.97; CI 95% (0.95-0.98) p < 2.2e-16] and an inter-observer reliability of 95% [r-squared = 0.95; CI 95% (0.90-0.97) p < 2.2e-16]. CONCLUSIONS: An approximation of the Cobb angle measure is possible with ultrasound by using the transverse processes as reference. This is a very rapid and simple system for assessing the principal spinal deformity measure in young people, although it does not allow estimating the associated axial or sagittal rotation. These slides can be retrieved under Electronic Supplementary Material.